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April 13, 2011 Newsletter Archive

"Death with Dignity" or Assisted Suicide?
Understanding the bill currently in the Vermont Senate

by Margaret Himmelsteib

When planning for the future, we frequently think of how best to protect and provide for our loved ones, through the use of wills and trusts. In addition, we set up advance directives and powers of attorney to facilitate end of life care. However, sometimes we fail to think of our own needs, and no matter how well we plan, unforeseen circumstances may dramatically change our intended plans. Where one's end of life arrangement previously appeared adequate, a diagnosis of terminal illness may drastically alter those plans.

Treatment of late-stage cancers or illnesses that have advanced to an untreatable phase can cause immense pain for individuals. In response, some states, such as Oregon and Washington, have passed legislation allowing terminally ill individuals to request medication to voluntarily end their lives.

Vermont has recently followed suit, with the "Death with Dignity" bill currently pending in the Senate. Identical legislation was introduced in 2009, but failed to pass; however, advocates of the current draft of the bill cite the support of newly elected Governor, Peter Shumlin. In addition the bill is supported by Patient Choices, a group that seeks to grant the most control possible to terminally ill individual's end of life choices. Opponents of the bill include the Vermont Right to Life Committee and doctors who find the legislation contrary to their duties as physicians and express concern that such legislation may exacerbate, rather than alleviate, the pressure felt by terminally ill individuals.

Though controversial, the proposed Vermont bill incorporates numerous safeguards to ensure that an individual acting under the bill is fully informed and voluntarily requests the medication. To begin, the individual must be a Vermont resident over the age of eighteen that has been diagnosed as terminally ill; that is, the individual has an incurable disease that will likely result in death within six months. Moreover, the individual must have the capacity to voluntarily request the medication and must initiate such a request to the attending physician. The individual must wait at least fifteen days and then reaffirm this request, both orally and in writing. This way, the patient has a two-week period to reflect on his or her decision.

Moreover, the attending physician must advise the patient of potential adverse effects from the mediation, as well as any alternate end-of-life care options, in order to ensure fully informed consent by the individual. Counseling and palliative care consultations are also involved in the process. Just prior to writing the prescription, the physician must inquire whether the individual is making an informed decision. Therefore, up to the moment an individual obtains the medication, he or she will continue to receive extensive information on his or her current medical state, the effects of the medication, the effects on immediate family members, and alternatives to the medication.

The law's rigid requirements preclude any other person from acting on the terminally ill individual's behalf. As capacity is required under the law, a guardian or agent under an Advance Directive may not make the decision to request end-of-life medication on behalf of a terminally ill ward or principal. As a result, the effect of the bill, if passed, will be limited to a very small group of qualified individuals.

When planning for end of life care, it is impossible to accurately predict what will occur. Though voluntarily ending one's own life is not necessarily an option one wants to rely on, future circumstances may make the option more attractive. Therefore, though only potentially affecting a very small handful of Vermonters, the bill could provide immeasurable relief for certain circumstances we do not necessarily contemplate while drafting life plan documents.